| NPI | 1891427142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OK 7633) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MI 2901601427) |
| Enumeration Date | 2022-06-27 |
| Last Update Date | 2022-06-27 |